CMS Pub. 100-04, ch. 32, § 350.4

United States

(Rev. 3287, Issued: 06-30-15, Effective: 04-21-15, Implementation: 04-21-15)

The following requirements must be met for payment to be made for emergency services received by Medicare

beneficiaries in foreign hospitals:

• The hospital must meet the definition of an emergency hospital and be licensed or approved by the appropriate

agency of the country in which it is located.

• The services meet the criteria of emergency services.

The foreign hospital must be closer to or substantially more accessible from the site of the emergency than the nearest

U.S. hospital that was adequately equipped and available to treat the illness or injury.

1. Emergency Occurred in the U.S. (See §350.1.B for definition of the U.S.)

If the individual was physically present in the U.S. at the time the emergency occurred, the individual's reason for

departure from the U.S. must have been specifically to obtain treatment at the foreign hospital. Services are not covered

where the person's departure from the U.S. is part of a trip abroad and the foreign hospital is more accessible simply

because the individual was in the process of travel. For example, the airplane on which the individual was traveling

could not readily return to permit the person's removal.

2. Emergency Occurred in Canada

If the emergency occurred in Canada, the beneficiary must have been traveling, without unreasonable delay, by the most

direct route between Alaska and another state. Benefits are not payable if the emergency occurred while a beneficiary

was vacationing. The requirement of travel without unreasonable delay by the most direct route will be considered met

if the emergency occurred while the beneficiary was enroute between Alaska and another state by the shortest

practicable route, or while making a necessary stopover in connection with such travel.

NOTE: An emergency occurring within the Canadian inland waterway between the States of Washington and Alaska is

considered to have occurred in Canada.

Ordinarily, the "shortest practicable route" is the one that results in the least amount of travel in Canada, consistent with

the mode of travel used between the point of entry into Canada and the intended point of departure. The amount of

travel in the U.S., prior to entering Canada is not pertinent. A route involving greater travel within Canada may be

considered the "shortest practicable route" if the additional travel resulted in a saving of time or was necessary because

of such factors as:

• Road or weather conditions;

• The age of the traveler;

• Health, or physical condition of the traveler;

• The need to make suitable travel arrangements; or

• The need to obtain acceptable accommodations.

However, the individual would be considered to have deviated from the "shortest practicable route" if the detour was

unrelated to the purpose of reaching their destination (e.g., for the principal purpose of sightseeing or vacationing).

The term "necessary stopover" means a routine stopover for rest, food, or servicing of the vehicle, and a non-routine

stopover (even though of significant duration) caused by such factors as unsuitable road or weather conditions, the

age, health, or physical condition of the traveler, the need to make suitable travel arrangements, or to obtain

acceptable accommodations.